Healthcare Provider Details

I. General information

NPI: 1376792507
Provider Name (Legal Business Name): TAI HOME HEALTHCARE SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 WAREHOUSE ST
GREENSBORO NC
27405-7228
US

IV. Provider business mailing address

PO BOX 13932
GREENSBORO NC
27415-3932
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-6700
  • Fax: 336-271-6802
Mailing address:
  • Phone: 336-271-6700
  • Fax: 336-271-6802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number251-E00000X-HOME HEA
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number251E00000X-HOME HEAL
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number251F00000X-HOME INFU
License Number StateNC

VIII. Authorized Official

Name: TAIWO TIJANI
Title or Position: DIRECTOR
Credential: R.N.
Phone: 336-271-6700